FOETAL MEDICINE.

Question 1

Name some key embryological features for the following dates:

6-7 weeks
7-8 weeks
12 weeks
13 weeks

Answer 1

6-7 weeks: heart beating, embryo 2-3cm in length
7-8 weeks: limb buds forming and kidneys formed (but not functioning)
12 weeks: bladder functioning, swallowing and stomach emptying established
13 weeks: abdominal wall closure

Question 2

What parameters are used to measure foetal growth?

Answer 2

Up until 12 weeks: crown-rump length

After 12 weeks: abdominal circumference, head circumference and foetal length (foetal biometry)

Question 3

What are the dates associated with each trimester?

Answer 3

Trimester 1: weeks 1-12
Trimester 2: weeks 13-28
Trimester 3: weeks 29-40

Question 4

The due date is calculated on how many weeks of pregnancy?

Answer 4

40 weeks

Question 5

When are routine scans offered and what are they for?

Answer 5

11-13+6: dating scan – offer Down’s syndrome screening

18-20+6: anomaly scan

Question 6

What percentage of women will be told that their pregnancy has a high risk of a serious abnormality?

Answer 6

3-5%

Question 7

Aetiology of congenital malformations?

Answer 7

Chromosomal abnormalities - 6%
Single gene defects - 7%
Environmental factors - 7%
Multifactorial - 25%
Unknown aetiology - 54%

Question 8

What environmental factors may cause congenital malformations?

Answer 8

Infection
Teratogens
Immune
Endocrine

Question 9

Name 5 examples of minor congenital malformations

Answer 9

Cleft lip and palate
Talipes
Mild renal pelvis dilation
Polydactyly
VSD

Question 10

Name 7 examples of major congenital malformations

Answer 10

Neural tube defects
Intracranial abnormalities
Major cardiac defects
Anterior abdominal wall defects
Major renal tract abnormalities
Skeletal dysplasia
Hydrops

Question 11

What percentage of newborns have a single minor congenital malformation?

Answer 11

14%

Question 12

What percentage of term babies will have a major malformation?

Answer 12

3%

Question 13

Which criteria do FASP aim to fulfill through their screening programme?

Answer 13

Identifying conditions where the baby may die shortly after birth
Identifying conditions which may benefit from treatment before birth
Facilitate planned delivery in an appropriate setting
Optimise treatment after the baby is born
Have detection rates which exceed 50%

Question 14

Which conditions are screened for (as a minimum) in England?

Answer 14

Anencephaly
Open spina bifida
Cleft lip
Diaphragmatic hernia
Gastroschisis
Exomphalos
Serious cardiac anomalies (TGA, AVSD, TOF, HLHS)
Bilateral renal agenesis
Lethal skeletal dysplasia
T18 
T13

Question 15

Which groups of women may not have equal access to screening?

Answer 15

Women in abusive relationships
Women with learning disabilties
Women who are homeless / not registered to a GP
Women who don’t have English as their first language
Women with physical disabilities (eg blind)
Women who are unaware that they are pregnant
Women with drug / alcohol problems

Question 16

What is the risk of miscarriage with amniocentesis?

Answer 16

1 in 200

Question 17

What is the risk of miscarriage with CVS?

Answer 17

1 in 100

Question 18

What is considered a high risk pregnancy for Down’s Syndrome?

Answer 18

1 in 150

At this risk level invasive testing can be offered on the NHS

Question 19

At what dates can CVS be offered? Amniocentesis?

Answer 19

CVS: 11-13+6 weeks
Amniocentesis: 15 weeks onwards

Question 20

What constitutes the quadruple test?

Answer 20

Serum AFP
b-hCG
Inhibin
Oestriol

Question 21

What is the law regarding TOP?

Answer 21

Up to 24 weeks two doctors must agree that continuation of the pregnancy will cause:

a) Risk to the woman’s life
b) Risk of grave permanent injury to the woman’s physical or mental health
c) The risk to the woman’s physical or mental health will be greater if she continues with the pregnancy than if she ends it.
d) The risk to her child(ren)’s physical or mental health will be greater if she continues with the pregnancy than if she ends it.
e) The fetus is likely to be born with severe physical or mental abnormalities as to be seriously handicapped.

Question 22

When is there no time limit on when a TOP can be offered?

Answer 22

There is no time limit on abortion where two doctors agree that continuing with the pregnancy would involve

1. Risk to the woman’s life
   b) Risk of grave permanent injury to the woman’s physical or mental health
   e) The fetus is likely to be born with severe physical or mental abnormalities as to be seriously handicapped.